A Quarterly Publication of the American College of Sports Medicine • www.acsm.org
Summer 2003
EXERCISE & THE OLDER ADULT
Never Too Late to Start When it
Comes to Exercise
by Martha Pyron, M.D.
Inside
There are so many reasons to start
exercising! First, you will feel great.
Just give it a try! Also, exercise has
been shown to improve heart and lung
function, reduce the risk of heart disease, decrease the chance of illness or
death from all causes, decrease anxiety
and depression, and even slow the
process of aging. For example, researchers found that many bodily
functions start to decline at a rate of two
percent per year after the age of 30.
But, with exercise, this aging process is
slowed to a rate of one-half percent per
year! This means that a person who
does not exercise will have lost 70
percent of their functional ability by the
age of 90. In contrast, a 90 year-old
exerciser will have only lost 30 percent
of their functional ability and still be 70
percent strong!
Although you may want to begin your
exercise program right now, you might
also be concerned about some of the
risks of exercise. By far, pulled muscles
and sprained ankles account for the
majority of injuries which occur while
exercising. Also, there is a small risk of
serious injury such as a heart attack or
collapse during exercise. Certain
medical conditions may put you at
higher risk for serious injury during
exercise, such as congestive heart
failure, diabetes, or heart attack. And
worrisome symptoms include chest
pain, irregular heartbeat, shortness of
breath, joint swelling, or trouble walking.
However, most chronic medical problems are significantly improved with
exercise. With proper exercise choices,
equipment, and warm-up, the rate of
injury is markedly decreased. To be on
the safe side, a mixed weight bearing
(walking) and non-weight bearing
(swimming) exercise regimen will
reduce the risk of joint injury.
Stretching and warming up is recommended prior to and after exercise to
help prevent muscle injury. It is best to
check in with your doctor if you have
any of the above medical concerns, a
family history of heart disease, or if you
are a man over 40 or a woman over 50.
With these precautions, the vast majority of older folks can safely start an
exercise program and live longer,
healthier lives.
LETTER FROM THE EDITOR
page 2
Q&A WITH ACSM
page 2
OLDER ADULTS: LOOK AT LIFESTYLE TO
INCREASE ACTIVITY
page 3
FLEXIBILITY IN AGING: STRETCHING TO
MEND THE BEND
page 5
STAY ACTIVE AFTER JOINT REPLACEMENT
page 6
EXERCISE AFTER MENOPAUSE
page 7
ACSM CURRENT COMMENT: RESISTANCE
TRAINING IN THE OLDER ADULT
page 8
THE ATHLETE’S KITCHEN
page 10
Now that we have reviewed the reasons
why to exercise, and the precautions to
take, let’s talk about the different types
of exercise.
www.acsm.org
®
(Continued on page 4, see Exercise)
1
Summer
2003
A Quarterly Publication of the American College of Sports Medicine • www.acsm.org
American College of Sports Medicine
FIT SOCIETY PAGE
®
ACSM Fit Society Page Editorial Board:
Jeffrey A. Potteiger, Ph.D., FACSM, Editor
Miami University
April Crommett, Ph.D.
Louisiana Tech University
Peter Grandjean, Ph.D., FACSM
Auburn University
Lisa K. Lloyd, Ph.D.
Southwest Texas University
Martha Pyron, M.D.
University of Texas
®
Bryan W. Smith, M.D., Ph.D.
University of North Carolina
Summer 2003
ACSM is the world’s largest association devoted to sports
medicine and exercise science. ACSM advances and integrates
scientific research to provide educational and practical applications of
exercise science and sports medicine.
For more information on subjects discussed in this issue and/or a
catalog of all ACSM publications, please send a self-addressed,
stamped envelope to: American College of Sports Medicine,
P.O. Box 1440, Indianapolis, IN 46206-1440.
Permission to reprint material from this publication is granted by
ACSM contingent upon manuscripts being reprinted in total
without alteration and on proper credit given to ACSM by citing
ACSM Fit Society Page, issue and page number; e.g., “Reprinted
with permission of the American College of Sports Medicine,
ACSM Fit Society Page, Summer 2003, p. 3.”
®
Katherine A. Beals, Ph.D., R.D.
Ball State University
Dixie L. Thompson, Ph.D., FACSM
University of Tennessee
®
Letter from the editor
Summer is one of the best and most convenient times of the year to assess our physical activity and health. Many of us take
our workouts outdoors in summer, and with vacations, holidays and warm, sunny weekends, we all have plenty of opportunity
to be active! For older adults, taking time to exercise has never been more important. In this issue of the ACSM Fit Society®
Page, sports medicine and exercise science experts examine Exercise and the Older Adult, profiling a number of important
health and fitness topics specific to this population. This issue gives older adults the specialized information they will need to
begin an exercise program. Resistance training, flexibility, increasing lifestyle activities, exercise following hip or knee replacement and menopause and exercise are addressed. And, don’t miss our regular features, including the Athlete’s Kitchen and
the popular Question and Answer section.
Enjoy this issue and consider using the tips and tools in the ACSM Fit Society® Page to enhance the health and wellness of
you and your family. If you have any questions or comments, please be sure to contact us.
Jeffrey A. Potteiger, Ph.D., FACSM
Editor, ACSM Fit Society® Page
E-mail: [email protected]
Q&A with ACSM
by Bryan Smith, M.D., Ph.D.
Q: What is the ideal surface for
walking?
A: As far as walking surfaces are
concerned, a cushioned surface is more
forgiving than a hard surface in terms of
the mechanical stress exerted on the
bones and supporting structures.
Ideally, a rubberized track or a grass
surface permits some impact loading
but less than an asphalt or concrete
surface. These cushioned surfaces
lower the potential for an overuse injury
such as a stress fracture. This is particularly important for folks who walk on the
tile-covered concrete floor at the local
mall for exercise.
If one’s exercise routine utilizes a hard
surface for impact activities such as
walking or jogging, it’s very important to
pay close attention to your shoes.
Proper fitting running shoes with good
shock-absorbing qualities are essential.
It’s equally as important to know when
to get new shoes. The shock-absorption characteristic of a good quality
running shoe lasts for 200-400 miles of
use. It’s not unusual for the shock
absorption properties of the shoe to
wear out before the shoe shows signs of
significant wear.
There are other factors to consider
when determining the ideal surface for
walking. Is the surface free of holes,
roots, and/or loose impediments? Is the
surface well lit? Is the surface hilly or
flat? If the surface is a road, what’s the
traffic like? Is the surface indoors or
outside to account for inclement
2
weather? Are others walking nearby so
you are not out alone?
Based on reviewing all the factors
involved, a hard surface may be preferential. If so, pay special attention to
exercise intensity and duration, as well
as your shoes, to avoid overuse injury.
Q: What’s the best exercise to stay
healthy?
A: There is no magic exercise. The
best exercise is the one (or better yet,
more than one exercise) you enjoy and
find the time to do. Getting 30 to 60
minutes of daily physical activity is far
better than getting no exercise at all, or
being sedentary. Consult with your
healthcare provider if you have special
needs or concerns.
A Quarterly Publication of the American College of Sports Medicine • www.acsm.org
Summer 2003
Feature
Older Adults: Look at Lifestyle to
Increase Activity
by Jan Schroeder, Ph.D.
Keywords: physical
activity, lifestyle
changes, health,
fitness
While some older adults thrive in
structured exercise programs, others
see it as a major inconvenience or
impossibility, and subsequently avoid
joining exercise groups. You understand the benefits of exercise, but dread
getting into the car and driving to the
gym or senior center to participate with
others, or you simply feel as though you
do not have time in the day to schedule
an exercise class. You are retired but
find yourself busier now than when you
were working! You may even feel as
though you are not physically able to
participate in an exercise program.
The good news is that you can still reap
most of the benefits of physical activity
and exercise just by being active during
the day. ACSM recommends a minimum of 30 minutes of physical activity
most days of the week to improve your
health. How can we improve our
cardiorespiratory endurance, muscular
strength and endurance, flexibility,
balance, and health in just 30 minutes a
day without performing planned exercise? The answer is to make small
changes that challenge your body
throughout the day.
Cardiorespiratory endurance or aerobic
fitness will help to reduce your risk of
cardiovascular disease, some forms of
cancer, and diabetes. Try to increase
the number of steps you take in the day
by parking a few spaces further from the
store entrance, walking a hole or two
while golfing, or playing with your
grandchildren. These suggestions are
small changes to help develop your
aerobic fitness. Take a walk with
someone to catch up on events instead
of calling or e-mailing. Go dancing! If
you would like a real challenge, take the
stairs instead of the elevator or escalator.
Improvements in your muscular strength
and endurance may help to reduce your
risk of osteoporosis, as well as reduce
your risk of falling. Try gardening; all
that weed pulling and digging is great
for the back muscles, while getting up
and down is excellent for developing
lower body muscles. Carry your groceries out to the car instead of using a cart
for upper body strength. Clean out the
garage, attic, or a closet; sorting all
those bits and pieces will definitely put
your muscles into motion. Or while you
are watching TV, perform resistancetraining exercises, such as chair stands
or biceps curls during the commercials.
Flexibility or the ability of the joints to
move through a range of motion is
important to maintain because of its
relationship towards activities of daily
living. Holding a position for 10-30
seconds can enhance your flexibility.
Make modest changes, like when
turning off the alarm, reach across the
body and hold that position, and sit up in
3
bed and open your arms wide to greet
the morning and stretch the chest.
While you are brushing your hair, drop
your arm behind the head for a triceps
stretch, and then as you are brushing
your teeth, put one foot behind you and
stretch out the calf muscles. As you sit
down to the breakfast table, perform a
spinal rotation to each side. As you sit
down to put on your shoes, lengthen the
leg and reach for your toes for a hamstring stretch. And finally, before you
put your car into gear, turn to look over
one shoulder and then the other, holding
each position. You will have completed
almost a full body flexibility program
before lunchtime!
Maintaining your balance is critical to
help reduce the incidence of falls.
Provide yourself with balance challenges throughout the day. When you
are standing in line at the grocery store,
you can work on balance by holding
onto your shopping cart and standing on
one leg. You can rise up on your toes
while you are washing dishes, or as you
are walking from one room to the next,
practice tandem walking by placing one
foot directly in front of the other, using
the wall for stability.
Simple, short activities done throughout
the day can improve your health and
fitness. Take the time to think of ways to
increase or enrich the quality of your
activity level. Remember, every movement that you make during your day is
an opportunity to move your body
toward better health and fitness.
A Quarterly Publication of the American College of Sports Medicine • www.acsm.org
Exercise
(Continued from page 1)
Flexibility
Stretch your muscles and tissues to
help prevent injuries and falls. Especially important areas to stretch include
the legs, back, neck, shoulders, and
ankles. Examples of stretching exercises can be demonstrated by an
exercise specialist, or can be reviewed
at the Web Site: http://www.nia.nih.gov/
exercisebook/chapter4.htm, which was
developed by the National Institute of
Aging. Flexibility training can be done
every day and should be a part of your
warm-up program.
Endurance exercise
This type of exercise increases your
breathing and heart rate by repetitive
body motion, improving the health of
your heart, lungs, and circulatory
system, as well as your stamina. It can
also delay or prevent many diseases
associated with aging such as diabetes,
colon cancer, heart disease, and stroke.
Examples of endurance exercises
include walking, swimming, jogging,
biking, and rowing. Endurance exercise
should be started and progressed
slowly, as this will help avoid injury. The
goal is to exercise for 30 minutes a day
at a level that increases your heart rate
and breathing but still allows you to talk
while exercising. You may need to start
at a slower rate and shorter time to
avoid injury.
Strength Training
Building muscles increases your metabolism and helps prevent osteoporosis. Examples include weight lifting,
going from sitting to standing, or lifting a
soup can or bag of rice. Strength
exercises should be done every other
day with three sets of eight to 12
repetitions for each exercise.
Balance Exercise
Enhancing your balance helps prevent
falls and injury. Exercises include
strengthening leg muscles and practicing standing on one leg. For a more
difficult exercise, try balancing while
Summer 2003
standing on a pillow; then try standing
on a pillow with only one leg.
One good strategy is to start exercising
30 minutes a day, with flexibility and
endurance training on some days and
strength and balance training on other
days. Vary the types of exercises to
keep things interesting, and pick exercises that are fun and interesting to you.
For example, stretching with your
neighbor or family member may be
more fun, or you may desire a walk
alone in the morning to begin your day.
Keep track of your progress for
motivation.
If you are not sure where to begin with
an exercise program, your doctor or
other healthcare professional can help
you. There are exercises to suit
everyone’s desires and needs. By
exercising, you will see improvements in
your daily activities, notice enhanced
feelings of wellness, as well as help
prevent many medical problems. So get
started and have fun!
ACSM and the Breakfast of Champions
Browse the cereal aisle at any grocery store right now
and check out boxes of the Breakfast of Champions.
ACSM and Wheaties® have embarked on an educational
partnership this year to provide health and fitness information on Wheaties ® boxes. Wheaties ® is committed to taking
their customers on a “personal fitness journey,” and have
partnered with ACSM to create reliable fitness tips.
From Championship boxes with sport-specific fitness
themes, to regular boxes with general health and fitness
information, Wheaties and ACSM will reach millions of
Americans with the latest fitness information, practical
health and fitness tips and cutting-edge science to motivate
people to be physically active. ACSM will share fitness
insights and knowledge through content printed on
millions of Wheaties boxes and featured on the Wheaties
Web site, Wheaties.com.
“ACSM is the most trusted source of fitness information in the country, but as a non-profit organization,
reaching a wide public audience with critical information is
a challenge,” said ACSM President W. Larry Kenney,
Ph.D. “By entering this first-of-its-kind partnership with
Wheaties, ACSM can funnel fitness information directly to
the breakfast tables of millions of Americans whom the
organization typically would not be able to reach.”
The Wheaties® tradition
of promoting fitness goes back
more than 70 years. In the
1930s, Babe Ruth and coach
Howard Jones advised “to
exercise and practice regularly” to get “a champion’s
energy, pep and speed.” In the
1950s, Bob Richards presided The wheaties.com Web Site
includes the official ACSM
over the Wheaties Sports
Federation, which encouraged seal and links to ACSM
related content.
physical fitness for all Americans.
“Helping Americans meet their fitness goals has been
a Wheaties ® mission for a long, long time, and this
partnership with ACSM will deliver important information
in a motivating style that is designed to lead people to real
results,” said Brian Kittelson, Wheaties marketing manager. “We are thrilled that The Breakfast of Champions
and the ACSM together will help fuel many more personal
championships in the years to come.”
Wheaties and ACSM will also be offering a free e-mail
bulletin for subscribers that will provide additional fitness
information supplementing the content on the cereal box.
4
A Quarterly Publication of the American College of Sports Medicine • www.acsm.org
Summer 2003
Feature
Flexibility in Aging: Stretching to
Mend the Bend
by Diane Austrin Klein, Ph.D.
We all age a little
each day, and with
aging come some
physiological
changes to our
musculoskeletal system and our flexibility. Losses in flexibility are as much the
result of disuse as they are to aging.
Reductions in joint range-of-motion
affect mobility and balance, impacting
routine physical functional status and
the ability to perform basic and instrumental activities of daily living (ADLs/
IADLs). Routinely performing flexibility
and stretching exercises can limit the
losses of flexibility over time. Although
many of us exercise regularly, stretching
before and after our exercise routines,
we may not be doing enough to maintain flexibility and physical function.
Defining Flexibility
To appreciate the impact of aging, we
must establish a common definition of
flexibility and understand the physiological changes affecting flexibility during
aging. Flexibility enables muscles and
joints to move through their full range of
motion. It has been defined as the
absolute range of movement in a joint or
series of joints that is attainable in a
momentary effort with the help of a
partner or a piece of equipment. Flexibility varies for each muscle and joint
group. The condition of the muscles,
joints, and connective tissues—including muscle fascia, ligaments, tendons,
collagen, and elastin — affects flexibility.
Aging and physical inactivity contribute
to the loss of flexibility over time. The
notion of “use it or lose it” is highly
applicable to flexibility and later affects
ability to function in our daily routines.
Several physiological changes affecting
flexibility occur with aging:
• Increased calcification, fraying, or
cracking in cartilage and ligaments
• Erosion of cartilage in heavily used
joints — particularly of the knees and
hands
• Decreased elasticity in joint capsules,
tendons, and ligaments with the
development of cross-linkages
between adjacent fibrils of collagen
• Increased dehydration and loss of
joint lubricants in connective tissue
• Changes in the chemical structure of
the tissues
Older adults experience greater flexibility losses than younger adults, but
activity can minimize losses. It has
been suggested that performing flexibility and stretching exercises stimulate
production and retention of connective
tissue lubricants and can reduce
flexibility losses.
Toward Healthier,
Successful Aging
Experts say three components for
“successful aging” include (1) avoiding
disease and disability; (2) maintaining
high cognitive and physical function;
and (3) continuing to engage in life (and
with others). These components focus
on overall lifestyle behaviors — good
dietary management, continuing education, socialization, and exercise. The
exercise component, particularly for
strength and flexibility enables high
physical function and avoidance of
disability.
Physiological changes in aging muscles
and joints affect mobility and limit
locomotion, including reduced muscular
work capacity and loss of muscle mass.
Increases in connective tissues and
cross-linkages add to muscle stiffness,
soreness, and tension. For older adults,
flexibility exercise is essential for aging
muscles to retain their flexibility and
5
protect them from injury. Older adults
are more susceptible to muscle injury
and it takes longer for their injuries to
heal properly. In many cases, healed
muscles may not perform as well as
prior to the injury.
Recommendations from the Centers for
Disease Control and Prevention and the
American College of Sports Medicine
have identified a need for older adults to
perform flexibility exercises, preferably
daily. Flexibility and stretching exercises should be performed in a slow,
sustained manner, holding stretches for
30 seconds. The stretch should be felt
in the muscle, not the joint. If arthritis or
muscle weakness is an issue, stretching
and flexibility exercise can be performed
in a warm pool to provide muscle
warming and buoyancy.
Stretching and
Flexibility Exercises
Flexibility training should be balanced
with strength training to prevent connective tissues from becoming too loose
and weak and being subject to damage
through overstretching or sudden,
powerful muscular contractions. The
key is to strengthen what we stretch and
stretch what we strengthen. When
performing both a stretching program
and a regular weight-lifting strengthtraining program, stretching should
occur after the weight-training program
so that muscles are warmed before the
stretching activity.
A variety of stretching and flexibility
exercise techniques attract older adults
because they are fun, easy to do, and
highly effective. These include Tai Chi,
Yoga, Pilates, and water exercises,
because of their ability to safely develop
both strength and flexibility. This results
(Continued on page 11, see Flexibility)
A Quarterly Publication of the American College of Sports Medicine • www.acsm.org
Summer 2003
Feature
Stay Active After Joint Replacement
by Paul S. Sherbondy, M.D.
Total joint replacement is one of the
most effective
surgical procedures
developed in the
20th century. Each
year, more than
500,000 joint replacements of the hip
and knee are performed in the United
States. Joint replacement is most often
performed on persons of retirement age
for unremitting joint pain caused by
osteoarthritis. There are numerous
other indications for joint replacement,
including arthritis from previous injuries
and rheumatoid arthritis. Once considered a surgical procedure for the aged,
joint replacements are now being
performed on patients 40 to 60 years of
age. While most common in the hip and
knee, surgical replacement of other
joints including the ankle, shoulder,
elbow, wrist, and fingers have been
developed.
Due in part to technological advances of
modern medicine, Americans enjoy an
ever-increasing life expectancy. We are
an “on-the-go” society, with commitments to work and family and the
pursuit of leisure-time activities. It is
increasingly unacceptable for us to have
our lifestyle limited by a painful joint.
We have also become a much more
athletic and health-conscious society.
Sports participation has increased
dramatically in the past half century, and
larger numbers of women enjoy sporting
activities. Athletics are not just for kids
anymore either. We chose to pursue an
expanding array of sporting activities
into adulthood. Unfortunately, athletic
participation also increases the risk of
serious joint injury that may lead to the
development of arthritis. Exercise is
also an important component of a
healthy lifestyle. Physicians often
recommend exercise programs to help
lose weight and control diabetes or high
blood pressure. We also exercise to
feel good and improve our self-image
and vitality. As we age, a painful knee
or hip can significantly affect our ability
to pursue recreational sports or exercise. Joint replacement is a surgical
procedure that can help us continue an
active lifestyle.
Normal joints are composed of cartilage
supported by underlying bone and
lubricated by joint fluid. They are
dynamic structures able to adapt to
changes in stress and activity. Arthritis
is an irreversible process that causes
wearing away of the cartilage. This
results in roughness of the joint surfaces
that can then lead to bone spurs,
crookedness, swelling and pain. Joint
replacement involves removal of the
diseased joint cartilage and a small
amount of the underlying bone. The
resected bone and cartilage is then
replaced with metal and plastic. The
metal portion is affixed to the bone and
the plastic is placed in between and
serves as the joint-bearing surface. The
metal implants are affixed to the bone
with special cement or the bone is
allowed to grow onto the implant surface
to provide stability.
An artificial joint does not have the
same dynamic ability to adapt to
changes as a normal joint. Therefore,
joint replacements unfortunately have a
finite lifespan. Normal stresses from
walking and movement cause microscopic wearing of the plastic spacer.
The interface between the bone and
implant also represents a potential weak
area. Breakdown of this interface can
lead to implant loosening. Joint replacements are also at risk for other complications including implant breakage,
dislocation and bone fracture above or
below the implant. Under normal
circumstances, the risk of these adverse
events occurring is minimal. Increased
activity and loading of the joint can
accelerate these processes. Exercise
and sports increase the risk of these
adverse events. Factors that can affect
these problems include the length of
time the implant is required to be in
place and the type and intensity of
activity performed. Activity levels
generally correlate to age, so the
younger a person is at the time of joint
replacement, the greater the likelihood
of developing problems.
There are several issues to consider for
those who wish to continue an active
lifestyle beyond that required for activities of normal daily living. The first is to
discuss the desired activity with your
surgeon and determine what activity is
permitted. Having this discussion
before surgery can help form realistic
expectations after surgery. Another
important issue is your prior experience
with the desired activity. It is more
realistic to continue to pursue a permissible exercise or sporting activity that
you are experienced with rather than
beginning one anew.
In general, after hip or knee replacement, most surgeons permit patients to
engage in stationary biking, dancing,
golf, swimming, walking, and doubles
tennis. With prior experience, lowimpact aerobics, road bicycling, bowling,
hiking, horseback riding, and cross
country skiing are usually permitted.
High impact activities such as racquetball, soccer, singles tennis, football,
basketball, softball, and jogging are not
permitted. Opinions vary on other
activities including weightlifting and
downhill skiing. There may also be
permanent restriction from kneeling with
total knee replacement and squatting
with total hip replacement. Heavy lifting,
carrying, and intensive manual labor are
also usually not permitted.
(Continued on page 11, see Active)
6
A Quarterly Publication of the American College of Sports Medicine • www.acsm.org
Summer 2003
Feature
Exercise after Menopause
by Dixie L. Thompson, Ph.D., FACSM
There are many
well-recognized
reasons for exercise: better heart
health, lower risk of
type 2 diabetes,
and weight management are just a few.
Unfortunately, many women fail to make
the time to exercise regularly, and
subsequently miss the benefits that
come from an active lifestyle. Some
women believe that exercise is more
important for men, while others confuse
being busy with getting adequate
exercise. Some older women also
mistakenly believe that it is too late to
begin an exercise program after menopause. However, a recent study
showed that women 65 or older who
increased their physical activity lowered
their risk of death during the follow-up
period by almost 50 percent! In fact,
there are many well-documented
benefits that can be gained by postmenopausal women when they exercise
regularly.
One of the benefits to regular exercise
is cardiovascular health. Regular
aerobic exercise reduces the risk of
dying from heart disease, lowers blood
pressure, and helps control cholesterol
levels. According to data from the
Women’s Health Study, women who
walk two or more hours per week
reduce their risk of coronary heart
disease by two-thirds. One of the
reasons that heart disease risk climbs in
women after menopause is the tendency for blood pressure to increase
with age. Researchers at the University
of Tennessee at Knoxville studied
previously sedentary, postmenopausal
women with elevated blood pressure
and found they were able to lower their
systolic blood pressure by walking
approximately two miles per day. This
reduction in blood pressure translates
into an approximate 20 percent lower
risk of coronary heart disease.
Bone health is a particular concern for
many postmenopausal women because
of the decline in bone density after
menopause. Approximately eight million
American women have osteoporosis,
and more than 30 million more have low
bone density, although not clinically low
enough to be diagnosed as osteoporosis. It is estimated that one-half of all
women over the age of 50 will have an
osteoporosis-related fracture. Exercise
and a healthy diet across the lifespan
are two ways to maximize bone health.
Once menopause is reached, it appears
that regular weight-bearing exercise can
help minimize bone loss. According to
data from the Nurses Health Study, the
risk of hip fracture in postmenopausal
women declines by six percent for every
hour per week spent walking. Strength
training, as a supplement to aerobic
exercise, can also be useful in maintaining bone.
A common complaint among postmenopausal women is weight gain. In
addition to weight gain, there are other
unhealthy menopause-related body
composition changes, such as a decrease in muscle mass and an increase
in abdominal fat. Although some of
these changes may be inevitable, the
magnitude of these changes can be
controlled. A large number of studies
have found that exercise during the time
around menopause is critical in minimizing fat accumulation. Postmenopausal
women who exercise regularly are much
less likely to be obese than their sedentary counterparts. In addition to maintaining regular exercise, it is important
that women recognize that a decrease
in resting metabolism occurs with age.
In order to prevent body fat gain, this
decrease in metabolic rate must be
matched by a decrease in caloric intake.
So, how much exercise is enough to
experience the benefits that have been
described? From a public health
7
standpoint, the Centers for Disease
Control and Prevention, the
American College of Sports Medicine
and the Surgeon General agree that 30
minutes of moderate aerobic exercise
on most, if not all, days of the week will
provide health benefits. It is important
to note, however, that this is a minimal
recommendation and greater benefits,
particularly in controlling weight, can be
achieved with additional exercise. The
specific type of exercise (walking,
swimming, cycling, etc.) seems less
important than the fact that the exercise
is performed regularly. Find a type of
exercise that you enjoy and that best
suits your individual needs.
Here are a few tips if you are a postmenopausal woman and just beginning
an exercise program.
• Make a commitment to exercise
regularly. Have contingency plans
when time conflicts, travel, weather
issues, or other unexpected issues
arise. Even if illness or emergencies
force you out of your routine, return to
your plan as quickly as possible.
Keeping a daily journal of your
exercise can be useful in helping you
monitor your commitment to exercise.
• Find an exercise support system. For
some women this will mean enlisting
an exercise buddy to work out with
you. For others it may mean finding
someone to talk with about the
struggles and successes that are
encountered with leading an active
lifestyle. People are much more
likely to continue exercising regularly
when they have supportive people
around them.
• Start out slowly and progress naturally. Too many people begin exercise programs that are either too
intense or too long in duration. This
often leads to frustration and/or injury.
Listen to your body – it will tell you if
(Continued on page 11, see Menopause
A Quarterly Publication of the American College of Sports Medicine • www.acsm.org
Summer 2003
ACSM Current Comment
Resistance Training in
the Older Adult
Written for the American College of Sports Medicine by Darryn S. Willoughby, Ph.D., CSCS, FACSM
The health benefits
of appropriately
prescribed long-term
(more than 12
weeks) resistance
training in older adults — ages 65 and
older — are well known. They include
improvements in muscle strength and
endurance; other possible health benefits
include increase in muscle mass, which
translates into improvements in functional capacity. In addition, increased
weight bearing with resistance training is
considered beneficial in improving bone
density and combating the effects of
osteoporosis. Achieving appropriate
levels of function is very important for
older adults so they are able to carry out
most of the daily living skills necessary to
lead independent lives. Due to the fact
that muscle wasting (sarcopenia) and
weakness, exacerbated by physical
inactivity, is prevalent in the aging
population, more emphasis has been
placed on developing resistance-training
programs for older adults. When developing resistance-training programs for
this group, important components to
consider are the various training-related
variables: frequency, duration, exercises,
sets, intensity, repetitions, and progression. Older adults often have orthopedic
issues that contraindicate resistance
training of the affected joint(s). Older
adults are also at a higher risk of cardiovascular disease, and in many cases
have even been diagnosed with it.
Therefore, it is critical that the older adult
receive prior approval from their physician before participating in resistance
training. It should be noted that proper
supervision of the individual’s resistancetraining program, including any testing
procedures, by an appropriately trained
exercise professional, is highly recommended. It should also be noted that
performing maximum strength testing in
many older adults is not recommended.
Therefore, when strength testing is
appropriate, sub-maximum testing
protocols for estimating maximum
strength are recommended.
Frequency
Frequency refers to the number of
exercise sessions per week. The traditional recommendation for frequency is
to engage in three training sessions per
week for individuals primarily seeking
improvement in their overall health and
fitness capacity. Even though some
individuals may be motivated to train
more frequently, resistance-training
studies with the elderly have indicated a
range of two to four days per week to be
effective and adequate in improving
strength. So the recommendation is that
the older individual train at least two days
per week but no more than four, suggesting an average training frequency of
three days per week. Also, the frequency
of exercise should be structured so that
there is at least 48 hours between
training sessions. An individual could
satisfy this requirement with a “total
body” routine, meaning that they would
exercise all of the chosen muscle groups
during each training session two or three
days per week. Another approach could
be a “split” routine where some of the
chosen muscle groups are exercised on
one or two days a week while the
remaining are exercised on a separate
one or two days. This “split” routine
approach may not be appropriate for
those older individuals who are just
beginning their program.
Duration
Duration describes the length of each
training session. In reference to training
duration, longer training sessions are not
necessarily more effective. If one has an
appropriately designed program based
8
on sound training variables, lengthy
training sessions are not necessary. In
fact, older adults should avoid lengthy
training sessions, because they may
increase the risk of injury, manifested by
extreme fatigue. Present guidelines for
resistance training in older adults recommend a range of approximately 20-45
minutes per session. In other words, one
should attempt to train for at least 20 but
no longer than 45 minutes. This range
suggests an approximate average
duration of 30 minutes per session.
Exercises
Exercise may be categorized as either
multi-joint, meaning more than one joint
is dynamically involved to perform the
exercise (e.g., bench press, shoulder
press, leg press), or uni-joint, meaning
only one joint is dynamically involved
(e.g., bicep curls, triceps extensions, leg
extensions). In the older adult, the
resistance-training program should
focus primarily on multi-joint exercises.
Uni-joint exercises are not discouraged
entirely but should not make up the
majority of exercises within the training
program. Additionally, machines are
recommended over free weights (i.e.,
barbells and dumbbells) due to skillrelated and safety factors. As the
individual progresses, they can use
freeweight exercises appropriate for
their level of skill, training status and
functional capacity.
Muscle Groups
Traditionally, muscle groups are classified as the following: 1) chest, 2)
shoulders, 3) arms, 4) back, 5) abdomen, and 6) legs. Specifically, the chest
group contains the pectoral muscles,
the shoulder group contains the deltoid,
rotator cuff, scapular stabilizers and
trapezius muscles, the arm group
(Continued on page 9, see Comment)
A Quarterly Publication of the American College of Sports Medicine • www.acsm.org
Comment
(Continued from page 8)
contains the biceps, triceps, and forearm muscles, the back group contains
the latissimus dorsi of the upper back
and the erector muscles of the lower
back, the abdomen group contains the
rectus abdominis, oblique, and
intercostals muscles, and the leg group
contains the hip (gluteals), thigh (quadriceps), and hamstring muscles. In the
older adult, it is important to attempt to
incorporate all six of these muscle
groups into the comprehensive resistance-training program.
Number of Exercises per
Muscle Group
It has been recommended that one to
two exercises per muscle group is
normally adequate. Noteworthy here is
to understand that by employing primarily multi-joint exercises in the resistance
training program one may actually
exercise more than one muscle group or
specific muscle per exercise. For
example, in performing the leg press
exercise the quadriceps, hamstrings,
and gluteal muscles are all involved
and, in many cases, this could eliminate
the need to perform any uni-joint
exercises for those particular muscles.
Order of Exercises and
Muscle Groups
If a person is performing both multi-joint
and uni-joint exercises for a particular
muscle group, it is recommended that
the multi-joint exercise(s) be performed
before the uni-joint exercise. Additionally, within each resistance-training
workout, larger muscle groups (i.e.,
legs, back, and chest) should be worked
before smaller muscle groups (i.e., arms
and shoulders).
Sets
Studies have shown improvements in
muscle strength employing ranges of
one to three sets of each exercise
during the training program. Based on
current guidelines, it would be recommended that the individual start with one
set of each exercise and, depending on
individual need, possibly progress up to
no more than three sets when the
fitness professional deems it appropriate. It should be noted, however, that an
average of two sets of each exercise
would be beneficial for most individuals.
To avoid excess fatigue, a two-to-three
minute rest period between sets and
exercises is recommended.
Intensity
Intensity refers to the amount of weight
being lifted, and is a critical component of
the resistance training program, considered by many fitness professionals to be
the most important training-related
variable for inducing improvements in
muscle strength and function. In other
words, the more weight lifted, the more
strength gained. Even though this may
not always be the case, the importance
of intensity in facilitating strength improvements is well documented. Intensity
is often expressed as a percentage of
the maximum amount of weight that can
be lifted for a given exercise (1RM). For
example, if someone who has a maximum effort of 100 lbs. on the bench
press exercise performs a set with
80 lbs., they would be training at 1RM of
80 percent. Studies have suggested that
older individuals are able to tolerate
higher intensities of exercise, up to
85 percent. However, research has also
shown intensities ranging from 65-75
percent of maximum to significantly
increase muscle strength. Therefore, in
order to increase strength while simultaneously decreasing the risk of musculoskeletal injury that often accompanies
higher intensities of resistance training, a
low-intensity to moderate-intensity range
of 65-75 percent is recommended.
Repetitions
Repetitions (reps) refer to the number of
times an individual performs a complete
movement of a given exercise. There is
an inverse relationship between intensity
and repetitions, indicating that as the
intensity increases the repetitions should
decrease. Based on previous research, a
rep continuum has been established that
demonstrates the number of repetitions
9
Summer 2003
possible at a given relative intensity. For
example, an intensity of 60 percent
relates to 16-20 reps, 65 percent = 14-15
reps, 70 percent = 12-13 reps,
75 percent = 10-11 reps, 80 percent =
8-9 reps, 85 percent = 6-7 reps,
90 percent = 4-5 reps, 95 percent = 2-3
reps, and 100 percent = 1 rep. In view of
the previously mentioned recommendations for an intensity of 65-75 percent of
maximum, this would suggest that for
each training exercise the individual
perform an adequate amount of weight
that would allow for 10-15 reps. In the
event that no initial strength testing was
performed, simply through trial-and-error
an individual could determine appropriate
training loads that would allow them to
perform only 10-15 reps. They could then
be sure of training at 65-75 percent of
maximum effort.
Progression and Variation
In order to continually enjoy improvements in strength and functional capacity,
it is important to consistently incorporate
progression and variation into the resistance-training program. Progressing and
varying one’s program commonly involves
incorporating the overload principle. The
overload principle involves making
adjustments to the training variables of the
resistance-training program such as
frequency, duration, exercises for each
muscle group, number of exercise for
each muscle group, sets and repetitions.
In terms of adjustment, normally the
overload principle involves making
increases to these variables. For example, making progressive increases in
intensity has been shown to be important
in increasing muscle strength. In terms of
the rate of progression, one should
consider attempting to progress their
resistance-training program on a monthly
basis. However, it should be noted that
increasing the intensity in some older
adults may be contraindicated due to
orthopedic and/or other medical limitations. As a result, making adjustments in
other training variables would be
recommended.
To read more Current Comments,
please visit the ACSM Web Site at
www.acsm.org.
A Quarterly Publication of the American College of Sports Medicine • www.acsm.org
Summer 2003
The Athlete’s Kitchen
What’s New in Nutrition
Information from
ACSM’s 2003 Annual Meeting
The American
College of Sports
Medicine (ACSM) is
the nation’s largest
group of exercise
scientists, sports medicine doctors and
sports nutritionists. The members meet
each year to present their research.
Below are some tidbits of nutrition and
exercise news that was presented at the
May 2003 meeting in San Francisco.
Performance
• Intramusclar fat — that is, fat that is
stored within muscles—can provide
up to 25 percent of the energy used
during endurance exercise. Athletes
may need two days to replenish intramuscular fat if they eat a high fat (40
percent) diet and even longer with a
lower fat diet (24 percent of calories;
at least 60 to 80 grams of fat).
Endurance athletes can and should
appropriately include nuts, peanut
butter, olive oil and other healthful
fats into their daily meals. Fat-free
diets are not conducive to optimal
fueling.
• If you exercise twice a day, your
morning coffee can still enhance your
afternoon effort. Cyclists (who were
accustomed to drinking coffee)
consumed the equivalent of two
mugs of coffee before a morning ride
to exhaustion. When they took more
caffeine before the afternoon exercise test, they performed similarly to
when they only had the morning
dose. Morning brew is enough!
• If you are tempted to buy oxygenated
water, think again. It does not supersaturate the blood with oxygen (and
thereby enhance performance). Yet,
you do want to drink enough fluids on
a daily basis––unlike a college
hockey team of which 14 of the 16
players starting the practice dehy-
drated. During the 90 minute practice, not one player drank enough to
match fluid losses. Be sure to know
your sweat rates and replace fluid
accordingly!
Hydration
For years, athletes have been told to
drink as much water as they can
tolerate. That’s no longer the case.
Endurance athletes — those who
exercise for more than four hours and
overhydrate with fluids that contain little
or no sodium — can experience hyponatremia (low blood sodium; associated with malaise and confusion at
least, and death at worst). A survey of
marathon runners who experienced
hyponatremia indicates they: 1) drank
more fluid during the marathon and 2)
had saltier sweat compared to others
who maintain normal sodium levels.
• Hyponatremia occurs more often in
women than in men. This might be
because women are more diligent
than men about drinking water, or it
might be related to menstrual cycle
hormones.
• Football players with a history of
severe muscle cramping during twoa-day summer practices drank less
fluid than cramp-free players. They
became more dehydrated and
experienced more muscle cramps.
They also had higher sweat rates,
and simultaneously higher sodium
losses. Consuming sports drinks is a
convenient way to boost sodium
intake. Pretzels and broth work too.
The bottom line: if you do extensive
exercise in the heat, you should know
your sweat rate as determined by
weighing yourself naked before and
after one hour of hard exercise with no
fluid intake (1 lb. weight loss = 16 oz.
sweat). You can then replace fluids
10
appropriately, preferably with sodiumcontaining fluids and foods that replace
sodium sweat losses. If your stomach is
sloshing, stop drinking.
Body Image
• When 700 young adults (average
age, 24 years) were asked how they
perceived themselves on the spectrum from very underweight to very
overweight, the women were more
likely to see themselves as more
overweight than their actual weight;
the men saw themselves as being
more underweight. High school and
collegiate runners hold similar
perceptions. When questioned, the
women reported wanting to be lighter
than their current weight. The male
runners, in comparison, wanted to be
a little larger.
• The male desire to be bigger is based
on perception, not the actual preferences of women. A survey of about
200 collegiate men and women
indicates 1) men believe the male
figure most attractive to women is
more muscular than the figure the
women actually chose; 2) women
prefer men with standard muscle, not
hulks!
• Weight lifting is associated with not
just improved strength but also
improved perception of self-esteem,
sports competence, coordination and
health.
Women
Rat studies suggest the loss of regular
menstrual periods that commonly
occurs in active females may be related
to inadequate calories, not excessive
exercise. Rats that did lots of exercise
but ate enough calories to support the
exercise program maintained regular
reproductive cycles. Rat studies also
(Continued on page 11, see Kitchen)
A Quarterly Publication of the American College of Sports Medicine • www.acsm.org
Flexibility
(Continued from page 5)
in improved balance and mobility and
the ability to perform ADLs and IADLs,
maintaining functional independence.
Active
(Continued from page 6)
Older adults beginning exercise programs should first obtain medical
clearance and then work with a certified
instructor. While exercise improves
overall “fitness,” their rate of adaptation
will be slower. Long-term goals are
achieved through slow progression, as
they adapt. Older adults should begin
at lower frequencies (two times/week),
start with shorter time periods (15-20
minutes) and at lower intensities. As
strength and endurance increase,
frequency, duration, and intensity may
be increased. Always begin the training
session with a warm-up and end with a
cool-down.
effective at relieving pain and improving
function. An active lifestyle including
some sports and exercise is usually
permitted afterwards. It is important to
have realistic expectations about future
activities after major joint replacement
and discuss desired activities with your
surgeon.
Joint replacement of the hip or knee is
Kitchen
(Continued from page 10)
suggest the bone loss associated with
amenorrhea is likely related to reduced
muscle mass as opposed to hormone
imbalances. Women need to eat
enough to support exercise, muscles
and menses.
• If you are a female athlete who has
stopped having menstrual periods, be
aware that many members of the
medical community lack knowledge
about the health problems associated
with amenorrhea. A survey suggests
only 53 percent of family doctors
Menopause
(Continued from page 7)
you are being too aggressive in your
approach. After a workout, you may
be slightly tired but should recover in
an hour.
• Get regular medical checkups. Most
doctors now encourage their patients
Summer 2003
recognized all three parts of the
female athlete triad (amenorrhea,
eating disorders, stress fractures) ––
as did 36 percent of pediatricians and
17 percent of gynecologists. If you are
told it’s normal for athletic women to
stop menstruating, find another M.D.!
Muscle
Consuming inadequate calories and
protein reduces the body’s ability to
build muscles. Hence, dieting athletes
should be sure to have a strong protein
intake (at least 0.5 gm. pro/lb.). Yet, if
you are severely undereating (such as
an athlete “making weight”), choosing a
protein-rich diet will not protect your
muscles. Soldiers who did exhaustive
to exercise regularly. When you visit
your physician, be sure to inform him/
her about any changes in your
exercise routine and ask questions as
needed. Be sure to inform your
physician immediately if you experience chest pain, have severe difficulty breathing, or injure a muscle or
joint.
11
military operations while eating inadequate calories lost the same amount of
muscle regardless if they ate a high (0.5
gm/lb) protein or lower protein diet.
Supplements
Should you take vitamins C and E to
decrease the inflammatory response
associated with muscle damage caused
by exercise? No. A study with healthy
athletes who did muscle-damaging
exercise suggests 400 mg. C and 800
mg. E generated no protective benefits.
Ultramarathoners who took 1,000 mg. C
and 400 mg. E also experienced no
benefits in terms of severity of muscle
damage and recovery rates. Eating
wisely works.
There are a number of resources for
information about exercise for the
postmenopausal woman. An excellent
source of information is the Web Site for
the National Institute of Aging
(www.nia.nih.gov). Their booklet,
“Exercise: A Guide from the National
Institute of Aging” has specific information about how to design your exercise
program and forms that can be helpful
in tracking your progress.